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	Epilepsy
	Definition
	Contrary to popular belief, epilepsy is not a specific disease, but a group of symptoms caused by many different conditions. These conditions all involve the tendency to excessive electrical excitability of the brain. This results in electrical discharges that are followed by sudden, recurrent, and transient changes of mental function or body movement. Common manifestations of epilepsy include impairment or loss of consciousness and muscle spasms or other involuntary motion. The general categories of seizures are: Generalized seizures: seem to affect all of the brain from the outset. Focal (partial) seizures: begin locally in a part of the brain. When focal seizures spread to involve all of the brain, they are called secondarily generalized seizures. The clinical pattern of attacks can be used to classify the specific types of epilepsy. Absence, or Petit Mal, Seizures: short and generalized, lasting only a few seconds, beginning and ending abruptly. The manifestations include brief lapses of consciousness during which the person stares ahead and sometimes rhythmically twitches the eyelids or face muscles. Whatever activity or behaviour is interrupted by the seizure can resume immediately when the seizure ceases. These brief seizures may occur up to several hundred times daily, are most common in children after the age of 2, and rarely begin after age 20. They may also stop after childhood. Tonic-Clonic, or Grand Mal, Seizure: the most familiar form of generalized convulsion. Characterized by a sudden and complete loss of consciousness, the person falls and the arms and legs stiffen (the tonic phase), before beginning a rhythmic jerking (the clonic phase). A high-pitched cry may be heard at the outset of the fit as a result of air being forced through the vocal cords. The victim may bite the tongue and be incontinent. These events are swift occurring within 2 minutes followed by a more relaxed state of unconsciousness for another minute or so. Afterward, the patient will be confused, sleepy, and uncooperative for 15 minutes to several hours before full recovery. Complex Partial Seizures, or Psychomotor Attacks: usually a consequence of electrical discharges involving the temporal lobe of the brain and varying considerably in their manifestations. Often the person experiences a warning, known as an aura, caused by the onset of seizure activity. The aura may be expressed as a disquieting sense that something is about to happen, or as fear, an unpleasant smell, abdominal sensation, or distortion in perception. Following the aura, consciousness is depressed, speech ceases, and the person performs automatisms automatic movements such as chewing, repetitive swallowing, fidgeting of the hands, or purposeless moving from place to place. After the attack, the person suffers momentary confusion and cannot remember details of the episode. Simple Partial Seizures: caused by seizure discharges affecting sections of the motor or sensory areas of the brain. In Jacksonian seizures (named for John Hughlings Jackson, the great English neurologist who first described them), hand or facial muscles on the side of the body opposite to the side of the brain showing abnormal electrical activity begin jerking movements. Nerve fibers controlling one side of the body originate on the opposite side of the brain and cross to the other side as they traverse the brain stem and extend into the body.
	Cause
	Research has not disclosed why neurons discharge excessively, although some people apparently inherit a predisposition to develop a form of epilepsy. In others, a head injury scars in the brain are associated with seizures. Brain tumors and strokes also account for a small number of cases. But in half the people with chronic epilepsy, the cause is unknown. In these individuals, seizures typically begin early in life, usually before the age of 20, and continue for many years.
	Diagnosis
	People with epilepsy need a careful physical examination by a neurologist, including a detailed seizure history. An electroencephalogram (EEG), measuring the electrical activity of the brain, is done in every case to document and define the nature of the electrical disturbance. Both a computed tomographic (CT) brain scan and magnetic resonance imaging (MRI) can provide useful information about the brain. The patient may also undergo blood tests and a lumbar puncture to obtain cerebrospinal fluid for analysis.
	Treatment
	Drugs. The vast majority of patients must take anticonvulsant drugs to control their condition. In general, carbamazepine (Tegretol), phenytoin (Dilantin), or phenobarbital is prescribed for partial and generalized tonic-clonic seizures, while valproate (Depakote) or ethosuximide (Zarontin) is appropriate for absence attacks. Several new drugs are undergoing clinical testing, and approval for use is anticipated. One recently approved drug, sabapentin (Neurotonin), is indicated for simple and complex partial seizures, or secondarily generalized seizures. Treatment with these drugs is tailored to each individual, and sometimes combinations of these medications (as well as others) are necessary. Surgical Treatment. Some people whose seizures cannot be controlled with medication find relief after surgical removal of abnormal tissue initiating the seizure activity. Before surgery, a team of neurologists, surgeons, psychologists, radiologists, and technologists evaluate the patient's condition and define the location of abnormal tissue. The goal is to minimize risk to healthy regions of the brain during surgery.
	Lifestyle Changes
	Epilepsy is a chronic illness that requires accommodations in lifestyle even though medication allows the vast majority of people with epilepsy to live normal lives. Children can participate in sports with only minimal restrictions. Safety through careful supervision is still necessary. Adults can continue working, although those with active seizures must not drive, work at exposed heights, or operate dangerous machinery. Driving restrictions may not be necessary if someone with epilepsy demonstrates an extended period of seizure control through treatment.